More than 1.5 million Americans reside in nursing homes, a number that is expected to rise dramatically over the next 20 years as the Baby Boomer generation ages. Approximately 80 percent of nursing home residents have painful diseases and at least 50 percent have significant cognitive impairment. Evidence suggests, however, that pain among nursing home residents is poorly assessed and inadequately managed, especially among those with dementia. Prior research has revealed that cognitively impaired persons verbally report less pain than intact elders do. This may be due, in part, to the tendency of cognitively impaired persons to verbally report less pain. No evidence is available, however, to indicate that persons with dementia feel less pain. In addition, most prior research has relied solely on self-report measures of pain, which may be biased by dementia-related memory and language deficits. Thus, observational measures of pain are greatly needed to detect pain in this vulnerable population. Before health care providers can effectively manage pain among elderly adults, they must be able to accurately assess it, especially in those who are less able to verbally report its presence. This proposed research would investigate verbal and non-verbal expressions of pain in elderly adults, with and without dementia. The sample will consist of 200 nursing home residents aged 65 and older, sampled roughly proportional to their age, gender, and ethnic/racial distribution in the population. Using a quasi-experimental design, an activity-based protocol (Keefe & Block, 1982) will be used to exacerbate pain. A multidimensional battery of pain and cognitive assessments will be used to investigate the following specific aims: 1) to confirm that persons with impaired cognitive status report less pain; 2) to investigate whether behavioral assessments of pain might be less sensitive to cognitive status effects; and 3) to investigate relationships between self-reported pain intensity and observed pain behaviors, and whether such relationships vary across cognitive status groups.